OIG conducted this audit to access how effectively Veterans Health Administration’s (VHA’s) Non-Recurring Maintenance (NRM) Program addressed its most significant maintenance needs. Expenditures increased from about $824 million in FY 2008 to $1.8 billion in FY 2013. During this same period, VHA’s reported their facility maintenance backlog increased from $7.2 billion to $10.7 billion. We found that VHA needs to increase the effectiveness of its NRM program. VA established an annual goal of reducing its overall maintenance backlog by 9.5 percent and had reasonable assurance that the NRM program funds were used for allowable NRM purposes. However, VHA did not have an adequate process to track how much of the over $1.8 billion NRM funds the medical facilities spent to address its nearly $10.7 billion identified facility maintenance backlog. VHA’s Facility Condition Assessment (FCA) inadequately assessed risks to patient safety and underestimated repair costs by $12.3 billion. Lastly, 74 of the 150 NRM construction projects reviewed were not completed within 1 year of their initial planned completion date. This occurred because VHA did not have an adequate process to track their NRM project expenses and adequately monitor expected results. VHA’s FCA did not assess patient safety risks and provide reasonable cost estimates for identified maintenance deficiencies. Additionally, VHA does not routinely monitor NRM project schedules. As a result, VHA has not been able to adequately identify how it is using NRM funds to achieve program goals or ensure projects are prioritized to correct significant maintenance deficiencies, including serious patient safety issues. In addition, VHA cannot ensure that their annual NRM budget requests are accurate or that they are taking timely corrective actions on NRM projects that miss project milestones. We recommended the Under Secretary for Health, the Executive in Charge for the Office of Management and Chief Financial Officer, and the Principal Executive Director, Office of Acquisition, Logistics, and Construction, standardize NRM accounting procedures, provide program guidance, assign risk levels, estimate more accurate repair costs, and monitor NRM project milestones. VA officials concurred with our recommendations and submitted acceptable corrective action plans.